LENGTHENING OSTEOTOMY OF THE IATROGENIC SHORT FIRST METATARSAL

Introduction: One of the complications of first metatatarsal osteotomies is metatarsalgia secondary to shortening of the first metatarsal. Conservative treatment with insoles is not acceptable to all patients and the traditional treatment of this condition is by shortening osteotomies of the lesser metatarsals (eg Weil, Helal)- the latter osteotomies themselves have complications of causing pain or stiffness in the lesser toes. Purpose: The aim of this work is to report our results of step cut metatarsal lengthening of iatrogenic first brachymetatarsia. Patients and Methods: 16 female patients had metatarsal lengthening of iatrogenic first brachymetatarsia. A typical Scarf type osteotomy was used in the first 4 cases and a simple step cut of equal thicknesses along the axis of the first metatarsal was performed in the next 12 procedures. Results : When 10mm lengthening was done, the metatarsalgia was relieved in all of the 6 patients, in contrary to only 50% relief of symptoms in the patients when less then 8mm lengthening was achieved. Conclusions: One stage step cut lengthening osteotomy of the iatrogenic short first metatarsal, when over 8mm length is achieved, is safe with good results and is a preferable alternative to shortening osteotomies of the lesser metarsals in the treatment of metarsalgia due to inappropriate shortening of the first metatarsal.